Jeanie Lerche Davis
Brunilda Nazario, MD
If you have fibromyalgia pain, hang in there -- pain relief is possible.
Today doctors have better insight into fibromyalgia, and are using many types of medications to treat its symptoms. Antidepressants, anticonvulsants, narcolepsy drugs, pain relievers, sleep aids -- when used to treat fibromyalgia symptoms, these medications alter brain chemistry to help reduce pain, improve sleep, and ease anxiety or depression.
Helping patients with fibromyalgia to function better is the top goal for treatment, says Kim Jones, PhD, president of the Fibromyalgia Information Foundation and associate professor at Oregon Health & Science University School of Nursing and Medicine in Portland.
"That's the key with fibromyalgia," she tells WebMD, "doing what we can to decrease the symptoms so patients can maintain employment, so they can be involved with family and community."
Treatment usually includes medication and aerobic exercise -- swimming or walking -- which research shows is important in controlling fibromyalgia pain, says Doris Cope, MD, director of Pain Management at the University of Pittsburgh School of Medicine.
"Everyone wants a magic pill,” Cope tells WebMD, “but a pill can't do everything."
In working with a patient, Jones targets the person’s top two or three worst fibromyalgia symptoms. Common fibromyalgia symptoms include deep muscle pain, fatigue, morning stiffness, headaches, sleep problems, constipation or diarrhea, memory problems, and anxiety or depression. But not all people with fibromyalgia suffer the same symptoms.
She looks at which symptoms are taking the biggest toll on the person’s life. Then she and the patient try various medications until they find the one -- or a combination -- that works.
"There's a bit of trial and error while you're trying to land on a good treatment," Jones says. Not every patient will respond well to a particular medication. It’s difficult to know which medication to try first. But working as a team during this trial and error phase is often an effective strategy.
If pain is the primary fibromyalgia symptom, Jones may prescribe a prescription pain reliever, an anticonvulsant, or an antidepressant.
Anticonvulsants, developed to treat seizures, help relieve many types of pain. Lyrica, an anticonvulsant, was the first medication approved by the FDA specifically for fibromyalgia pain.
Two more antiseizure drugs are being studied as fibromyalgia medications -- Neurontin and Ativan.
Antidepressants are very helpful in relieving fibromyalgia pain and improve deep restorative sleep. They work by balancing serotonin and other brain chemicals involved in pain processing.
The new selective SNRIs (serotonin and norepinephrine reuptake inhibitors) help relieve fibromyalgia pain, whether the patient is depressed or not. SNRIs include Cymbalta and Effexor. Cymbalta is the only antidepressant approved by the FDA to treat fibromyalgia pain. Effexor is also used to relieve fibromyalgia pain. The FDA has also approved the SNRI Savella to treat fibromyalgia. A caveat for SNRIs: These drugs cannot be used if the patient takes a type of drug called monoamine oxidase inhibitor (MAOI) or has narrow angle glaucoma.
Combination antidepressants: At times, a combination of antidepressants can help reduce muscle pain, anxiety, and depression in fibryomyalgia. Patients also get more restful sleep, feel less fatigue, and have an overall better sense of well-being.
Pain relievers such as Ultram and Ultracet can help break cycles of fibromyalgia pain, relieve flare-up pain, and reduce muscle spasms. The muscle relaxant Flexeril can help reduce pain and improve sleep. Local injections of painkillers and/or cortisone at painful trigger points can be especially effective in breaking cycles of pain and muscle spasm.
Insomnia is a big problem in people with fibromyalgia. Research shows that frequent disruptions in sleep prevent growth hormone -- an important restorative hormone -- from being produced by the body. Without growth hormone, muscles don't fully heal and neurotransmitters (like serotonin) are not replenished.
Without deep sleep, the body can't recuperate from the day's stresses. This can overwhelm the body’s systems, creating a great sensitivity to pain.
In some patients with fibromyalgia, there is an underlying cause for insomnia, such as restless leg syndrome or sleep apnea. If it's not clear what's causing the sleep problem, Jones will prescribe one of several medications to help with sleep.
Cope considers sleep aids to be a last resort. "We can give you medication for sleep, but we have to be careful," she tells WebMD. "We don't want to take over the body's ability to produce neurochemicals -- or it will stop producing them."
Chronic pain is tough to beat, so you need every bit of help you can get.
Exercise boosts the body's natural production of serotonin (the mood-enhancing brain chemical). It also improves blood flow to muscles, releases stress and tightness, improves sleep, all of which helps relieve pain, Cope tells WebMD.
Other lifestyle approaches also help with fibromyalgia. “Stress reduction, relaxation techniques, prayer, yoga, visual imagery -- those help, too,” Cope says. “Try different things. Find what works for you. These things will make a difference."
But complete relief from fibromyalgia pain is not always possible, Cope admits. “If your pain is moderate but you're living a normal life, going to work, we've made progress.”
SOURCES:Doris Cope, MD, director of pain management, University of Pittsburgh School of Medicine.Kim Jones, PhD, president, Fibromyalgia Information Foundation; associate professor, Oregon Health & Science University School of Nursing and Medicine, Portland.WebMD Medical Reference: "Fibromyalgia Treatment: Medications That Can and Can't Help."Arnold, L. Arthritis Research and Therapy, June 23, 2006.Fibromyalgia Information Foundation: "An Overview."WebMD Feature: "Diagnosing Fibromyalgia."WebMD Medical Reference: "Insomnia Medications."WebMD Medical Reference from eMedicineHealth: "Sleep Disorders: Treatments for Narcoplepsy."Clinicaltrials.gov: "Trial Comparing the Effects of Xyrem (Sodium Oxybate) With Placebo for the Treatment of Fibromyalgia."
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